Healthcare Provider Details

I. General information

NPI: 1962015610
Provider Name (Legal Business Name): MARISA NACHELLE RAYFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 ENTERPRISE PKWY
SOLON OH
44139-2755
US

IV. Provider business mailing address

6150 ENTERPRISE PKWY
SOLON OH
44139-2755
US

V. Phone/Fax

Practice location:
  • Phone: 330-486-5386
  • Fax:
Mailing address:
  • Phone: 330-486-5386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2505078
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: